NPIMap

Individual provider Active NPI

Dragan S Petakov, MD

  • Internal Medicine Physician
  • Lowell, MA
National Provider Identifier
1629030622
Registry record updated May 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
157347 Issued in MA
Practice address
275 Varnum Ave
Ste 201
Lowell, MA 01854
Phone
(978) 452-9700
Fax
(978) 441-6075
NPI assigned
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 157347 MA Primary

Addresses

Primary practice location

275 Varnum Ave
Ste 201
Lowell, MA 01854

Mailing address

275 Varnum Ave
Ste 201
Lowell, MA 01854
Phone (978) 452-9700

Other identifiers 3

IdentifierTypeStateIssuer
0160750MedicaidMA
J24518OtherMABLUE SHIELD
0158658MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080207000553 MA Practitioner - Internal MedicinePractitioner - Hospice/Palliative Care 0042308165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverside Medical Group PCGroup PAC ID 5193612919, 12 clinicians

Practice addresses (Care Compare)

275 Varnum Ave
Suite 201
Lowell, MA 01854-2141
Phone (978) 452-9700

Hospital & facility affiliations

  • Tufts Medicine Care at Home Home health agency, Lowell, MA, CCN 227206
  • Pathways Healthcare Home health agency, Westwood, MA, CCN 227569
  • Amedisys Home Health Care Home health agency, Wakefield, MA, CCN 227211
  • Beacon Hospice, an Amedisys Company Hospice, Charlestown, MA, CCN 221544
  • Tufts Medicine Care at Home Hospice, Lowell, MA, CCN 221508
  • Lowell General Hospital Hospital, Lowell, MA, CCN 220063
  • D'Youville Care for Advanced Therapy Nursing home, Lowell, MA, CCN 225777
  • D'Youville Senior Care Nursing home, Lowell, MA, CCN 225515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Diagnostic Services, Inc Past Accepting new patients
Norwell Visiting Nurse Association, Inc Past Accepting new patients
D'Youville Senior Care, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: dpetakov31681@tuftsmedicine.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1629030622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 VARNUM AVE",
            "address_2": "STE 201",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01854",
            "telephone_number": "978-452-9700",
            "fax_number": "978-441-6075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 VARNUM AVE",
            "address_2": "STE 201",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01854",
            "telephone_number": "978-452-9700",
            "fax_number": "978-441-6075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETAKOV",
        "first_name": "DRAGAN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "157347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160750",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "J24518",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0158658",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

Verify at the official NPI Registry.